ASCO: Vinegar Test May Reduce Cervical Ca Deaths

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This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Biennial visual inspection with vinegar (acetic acid) reduced cervical cancer mortality by nearly one-third in a study in India, where cytology-based screening is not widespread.

Vinegar screening is done by applying vinegar on a cotton swab to the cervix, and if the spot turns white within 60 seconds, it means there are pre-cancerous changes in the tissue.

CHICAGO -- Vinegar has been used for everything from cleaning refrigerators to taming foot odors, and now this common kitchen staple may reduce cervical cancer deaths as well, researchers reported here.

In a 12-year randomized study of 150,000 women in India, biennial visual inspection with vinegar (acetic acid) reduced cervical cancer mortality by 31%, compared with no screening, reported Surendra Srinivas Shastri, MD, from the Tata Memorial Hospital in Mumbai, and colleagues at the American Society of Clinical Oncology annual meeting.

"We now have a method which could in a very simple way reduce cervical cancer mortality in low-resource countries like India," Shastri said.

Cervical cancer is the leading cause of cancer death in Indian women, and India accounts for 30% of the global burden of cervical cancer deaths, he said.

Pap smear screening isn't feasible because the country doesn't have the necessary health-care infrastructure, such as diagnostic laboratories and trained health care workers, said Shastri.

There's a cost issue, too. The vinegar screening test costs less than $1 per patient, while Pap smear or HPV DNA testing run about $15 per test, he said.

Looking for a simpler alternative, the researchers randomly assigned women, ages 35 to 64 years, with no prior history of cancer to biennial screening with vinegar (75,360 women) or no screening (76,178 women), which is the current standard of care in India. The study was conducted from 1998 to 2002 with 12 years of follow-up.

The vinegar used in the test is a sterilized combination of acetic acid with water -- not your regular off-the-shelf household vinegar.

Trained personnel -- 10th graders were used in the study -- used a cotton swab to apply the solution to the cervix. Cancerous and precancerous cells have more proteins in the nucleus than healthy cervical cells, and they aggregate into a whitish mass within a minute, Shastri said.

The incidence of invasive cervical cancer was similar between the two groups: 26.74 per 100,000 (95% CI 23.41-30.74) in the screening group versus 27.49 per 100,000 (95%CI 23.66-32.09) in the control group. This suggests that screening didn't lead to overdiagnosis, he said.

The researchers estimated this strategy could prevent 22,000 cervical cancer deaths every year in India and close to 73,000 in resource-poor countries worldwide.

The trial was supposed to continue until 2016, but was halted last year at the recommendation of an independent oversight committee due to the overwhelming benefits in the screening group, Shastri said. The government has already started rolling out the program nationally, a process that will take at least 2 years, he said.

The fact that the screening results were known immediately and women treated promptly is a real plus in rural areas where women might otherwise have to travel for hours to see a doctor, commented Carol Aghajanian, MD, of Memorial Sloan-Kettering Cancer Center and a member of the ASCO Communications Committee. Electra Paskett, PhD, of The Ohio State University in Columbus, agreed and told MedPage Today that the test will save lives.

"Showing that a screening test reduces mortality is the gold standard, and that had not been done before. Now we have a large randomized trial in a low-resource country showing the vinegar test meets that standard," said Paskett, who was the discussant for the study.

It could also be used in low-resource pockets in the U.S. that don't have access to or can't afford Pap smears or HPV DNA tests, she said.

Previous studies have shown that Pap smears and vinegar screens are comparable in accuracy, Paskett added.

The U.S. National Institutes of Health and Women's Cancer Initiative, an Indian nonprofit group, helped fund the study.

The researchers and Paskett reported no conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco

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